The profiles of patients with fulminant hepatic failure (FHF) from developing countries have not been reported earlier. The current study was conducted prospectively, at a single tertiary care center in India, to document the demographic and clinical characteristics, natural course, and causative profile of patients with FHF as well as to define simple prognostic markers in these patients. Four hundred twenty-three consecutive patients with FHF admitted from January 1987 to June 1993 were included in the study. Each patient's serum was tested for various hepatotropic viruses. Univariate Cox's regression for 28 variables, multivariate Cox's proportional hazard regression, stepwise logistic regression, and Kaplan-Meier survival analysis were done to identify independent predictors of outcome at admission. All patients presented with encephalopathy within 4 weeks of onset of symptoms. Hepatotropic viruses were the likely cause in most of these patients. Hepatitis A (HAV), hepatitis B (HBV), hepatitis D (HDV) viruses, and antitubercular drugs could be implicated as the cause of FHF in 1.7% (n= 7), 28% (n= 117), 3.8% (n= 16), and 4.5% (n= 19) patients, respectively. In the remaining 62% (n= 264) of patients the serological evidence of HAV, HBV, or HDV infection was lacking, and none of them had ingested hepatotoxins. FHF was presumed to be caused by non-A, non-B virus(es) infection. Sera of 50 patients from the latter group were tested for hepatitis E virus (HEV) RNA and HCV RNA. In 31 (62%), HEV could be implicated as the causative agent, and isolated HCV RNA could be detected in 7 (19%). Two hundred eighty eight (66%) patients died. Approximately 75% of those who died did so within 72 hours of hospitalisation. One quarter of the female patients with FHF were pregnant. Mortality among pregnant females, nonpregnant females, and male patients with FHF was similar (P > .1). Univariate analysis showed that age, size of the liver assessed by percussion, grade of coma, presence of clinical features of cerebral edema, presence of infection, serum bilirubin, and prothrombin time prolongation over controls at admission were related to survival (P < .01). The rapidity of onset of encephalopathy and cause of FHF did not influence the outcome. Cox's proportional hazard regression showed age > or = 40 years, presence of cerebral edema, serum bilirubin > or = 15 mg/dL, and prothrombin time prolongation of 25 seconds or more over controls were independent predictors of outcome. Ninety-three percent of the patients with three or more of the above prognostic markers died. The sensitivity, specificity, positive predictive value, and the negative predictive value of the presence of three or more of these prognostic factors for mortality was 93%, 80%, 86%, and 89.5%, respectively, with a diagnostic accuracy of 87.3%. We conclude that most of our patients with FHF might have been caused by hepatotropic viral infection, and non-A, non-B virus(es) seems to be the dominant hepatotropic viral infection among these patients. They presented wi...
Background: Temporomandibular disorder is a term used to describe problems involving temporomandibular joint, muscles of mastication, occlusion characterized by symptoms such as pain, restricted movements and intermittent joint sound. The present study was conducted to determine prevalence of TMD and to describe its association with parafunctional habits. Materials and Methods: A cross-sectional study was carried out among 345 undergraduate students of KIST Medical College and Hospital. Study population was selected by simple random sampling and the Fonseca Anamnestic Questionnaires were distributed. Data analysis was done in SPSS version 16 . Results: The prevalence of TMD was 47.4% with mild and moderate type of TMD present. The most common habit was chewing gums followed by biting of lips and biting of objects. Statistically significant difference in TMD groups was observed in clenching and grinding of teeth, biting of lips and biting of objects (p<0.001). There was statistically significant association between TMD and the signs and symptoms such as headaches, difficult to open mouth, muscular pain while chewing (p<0.001). Conclusions: A statistically significant association was found between biting of lips, grinding of teeth and mouth breathing with TMD.Keywords: parafunctional habits; prevalence; TMD .
Introduction: Medical emergencies can occur in dental practice anytime. Changing demographics in the population and increased life expectancy have resulted in more people having medical conditions which predispose to a medical emergency.Objective: To find the prevalence of medical emergencies in dental practice in Nepal, to assess the preparedness of dentists to manage emergency situation, to find out the ways to improve their preparedness, and to determine the factors affecting the occurrence of medical emergency.Materials & Method: A cross-sectional study using self-administered questionnaire was done among one hundred and twenty four participants present at the 16th Annual Dental Conference. The questionnaire consisted of 15 questions. The data were analyzed using chi-square test and cross tabulation was performed to evaluate categorical variables at a significant level of p< 0.05.Result: The percentage of respondents who reported at least one emergency situation was 37.1%. Majority of the events occurred during oral surgical treatment. According to the survey, the most frequently encountered emergency condition was vasovagal syncope followed by hypoglycemia and seizures. The emergency events were managed by the respondents through various modalities. The dental graduates despite BLS training were found to feel incompetent to manage emergency events.Conclusion: Medical emergencies in dental practice in Nepal are frequent and not as rare as anticipated. Thus periodic training should be provided to improve necessary clinical skills.
Background: Evidences on dental anxiety scale are essential in dental practice for better service delivery. The main objective of this study was to determine the anxiety level of patients undergoing oral surgical procedures and explore its associated factors.Methods: This was a cross sectional study enrolling 142 patients. Semi structured questionnaire based on Corah’s dental anxiety scale was prepared and administered to gather information. Descriptive statistics, chi- square test and independent t- test were used to analyze the data.Results: Sixty nine percent were feeling relaxed in waiting area. Nine patients (6.3%) were afraid of persons in white attire. About 17% reported that they were afraid of sound of dental apparatus. Many participant (81%) expected better outcomes of their dental procedures. When waiting for their procedure at the waiting area, about 50% stated to sense restlessness. Nearly 56% felt unease while waiting at dental chair. Nearly 70 % of cases had less than 7 dental anxiety scale score indicating low anxiety to dental procedures, 23.2% showed moderate anxiety with score of 7 to 9 and 7% showed high anxiety by scoring 10 or more out of score of 15.Average dental anxiety scale scores did not vary as per age differences. The anxiety scores for both sexes were alike.Conclusions: Even though anxiety level was low among the cases undergoing oral surgical procedure, being in waiting area and dental chair raises their apprehension.
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